L8511 HCPCS code: Insert for indwelling tracheoesophageal prosthesis, with or without valve, replacement only, each
L8511 is the HCPCS Level II code for insert for indwelling tracheoesophageal prosthesis, with or without valve, replacement only, each. The 2026 Medicare DMEPOS fee schedule pays $87.41 to $104.86 depending on the state. Its Medicare coverage code is C (Carrier judgment): Coverage is decided by the Medicare contractor (MAC) case by case. The NCCI unit limit is 1 per day on DME suppliers. Medicare volume rose 18% from 2022 to 2024 (342 to 402 services). In 2024, 2 suppliers billed Medicare for L8511 (purchases), serving 231 beneficiaries; Florida, Pennsylvania, New York accounted for 41% of services. Its average fee ranks 5 of 10 L85 codes (family range $2.66–$885.39).
Code details
| Field | Value |
|---|---|
| Section | L codes — Orthotic and prosthetic procedures and devices |
| Coverage code | C — Carrier judgment |
| Pricing indicator | 38 — DMEPOS: orthotics, prosthetics, prosthetic devices and vision services |
| BETOS category | D1F — Prosthetic and orthotic devices |
| Added | 2004-01-01 |
| Last action effective | 2004-01-01 |
2026 Medicare DMEPOS fee schedule for L8511
| Modifier | Meaning | Lowest state fee | Highest state fee | Ceiling | Floor |
|---|---|---|---|---|---|
| — | base fee | $87.41 | $104.86 | $106.67 | $80.01 |
| State | Modifier | Fee | Rural fee |
|---|---|---|---|
| AK | — | $87.41 | — |
| AL | — | $90.05 | — |
| AR | — | $90.03 | — |
| AZ | — | $87.41 | — |
| CA | — | $87.41 | — |
| CO | — | $90.54 | — |
| CT | — | $87.41 | — |
| DC | — | $87.41 | — |
| DE | — | $87.41 | — |
| FL | — | $90.05 | — |
| GA | — | $90.05 | — |
| HI | — | $87.41 | — |
| IA | — | $89.15 | — |
| ID | — | $87.41 | — |
| IL | — | $89.55 | — |
| IN | — | $89.55 | — |
| KS | — | $89.15 | — |
| KY | — | $90.05 | — |
| LA | — | $90.03 | — |
| MA | — | $87.41 | — |
| MD | — | $87.41 | — |
| ME | — | $87.41 | — |
| MI | — | $89.55 | — |
| MN | — | $89.55 | — |
| MO | — | $89.15 | — |
| MS | — | $90.05 | — |
| MT | — | $90.54 | — |
| NC | — | $90.05 | — |
| ND | — | $90.54 | — |
| NE | — | $89.15 | — |
| NH | — | $87.41 | — |
| NJ | — | $87.41 | — |
| NM | — | $90.03 | — |
| NV | — | $87.41 | — |
| NY | — | $87.41 | — |
| OH | — | $89.55 | — |
| OK | — | $90.03 | — |
| OR | — | $87.41 | — |
| PA | — | $87.41 | — |
| PR | — | $104.86 | — |
| RI | — | $87.41 | — |
| SC | — | $90.05 | — |
| SD | — | $90.54 | — |
| TN | — | $90.05 | — |
| TX | — | $90.03 | — |
| UT | — | $90.54 | — |
| VA | — | $87.41 | — |
| VI | — | $104.86 | — |
| VT | — | $87.41 | — |
| WA | — | $87.41 | — |
| WI | — | $89.55 | — |
| WV | — | $87.41 | — |
| WY | — | $90.54 | — |
How the L8511 fee compares
| Measure | Value |
|---|---|
| Rank among 10 L85 codes (lowest = 1) | 5 |
| Family fee range (average of state fees) | $2.66–$885.39 |
| Rural fee uplift | — |
Who bills L8511 (2024)
| Measure | Value |
|---|---|
| Suppliers billing rentals | — |
| Suppliers billing purchases | 2 |
| Referring clinicians | 176 |
| Medicare beneficiaries | 231 |
| States with claims | 13 |
| Share of services in top 3 states (Florida, Pennsylvania, New York) | 41% |
| Year | Suppliers | Beneficiaries |
|---|---|---|
| 2022 | 5 | 226 |
| 2023 | 5 | 204 |
| 2024 | 2 | 231 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for L8511, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 342 | 226 | $74.56 | $57.69 |
| 2023 | 327 | 204 | $76.88 | $58.27 |
| 2024 | 402 | 231 | $79.31 | $60.72 |
States with the most L8511 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| Florida | 42 | $57.54 |
| Pennsylvania | 41 | $62.34 |
| New York | 40 | $62.77 |
| California | 26 | $61.89 |
| North Carolina | 22 | $60.38 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| DME suppliers | 1 | Clinical: Data |
| outpatient hospital claims | 1 | Nature of Equipment |
| practitioner claims | 1 | Nature of Equipment |
What changed for L8511
- 2026-01-01: Average state fee rose 2.0%: $87.69 to $89.44
- 2004-01-01: L8511 added to HCPCS Level II
- Next scheduled CMS quarterly update (HCPCS and DMEPOS fee schedule): 2027-01-01
Frequently asked questions
What is HCPCS code L8511?
L8511 is the HCPCS Level II code for insert for indwelling tracheoesophageal prosthesis, with or without valve, replacement only, each. Short descriptor: "Indwelling trach insert".
How much does Medicare pay for L8511?
Under the 2026 DMEPOS fee schedule, non-rural state fees are base (base fee): $87.41–$104.86. Rural fees can be higher.
Does Medicare cover L8511?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
Did the Medicare fee for L8511 change in 2026?
The average non-rural state fee moved from $87.69 in 2025 to $89.44 in 2026 (+2.0%). CMS's next quarterly HCPCS and DMEPOS update takes effect January 1, 2027.
How many units of L8511 can be billed per day?
1 on DME suppliers; 1 on outpatient hospital claims; 1 on practitioner claims (NCCI medically unlikely edits).
Related L85 codes
- L8500 — Artificial larynx, any type ($704.63–$1,077.27)
- L8501 — Tracheostomy speaking valve ($107.37–$197.18)
- L8505 — Artificial larynx replacement battery / accessory, any type
- L8507 — Tracheo-esophageal voice prosthesis, patient inserted, any type, each ($50.34–$55.40)
- L8509 — Tracheo-esophageal voice prosthesis, inserted by a licensed health care provider, any type ($131.24–$144.37)
- L8510 — Voice amplifier ($303.69–$334.05)
- L8512 — Gelatin capsules or equivalent, for use with tracheoesophageal voice prosthesis, replacement only, per 10 ($2.59–$3.12)
- L8513 — Cleaning device used with tracheoesophageal voice prosthesis, pipet, brush, or equal, replacement only, each ($6.24–$7.46)
- L8514 — Tracheoesophageal puncture dilator, replacement only, each ($113.31–$136.01)
- L8515 — Gelatin capsule, application device for use with tracheoesophageal voice prosthesis, each ($75.84–$83.45)
Building a device that would bill under a code like this? Caduvo matches a device description to HCPCS/CPT codes, Medicare coverage and payment, and the FDA pathway in one report.
Next steps
- Run a reimbursement report for a device billed under L8511
- Watch L8511 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for L8511
Sources: CMS HCPCS Level II release October 2025; CMS DMEPOS fee schedule 2026; CMS NCCI MUE tables; CMS Medicare utilization (physician and DME supplier files); CMS Medicare Coverage Database articles. Fees are Medicare allowables, not commercial rates. Not billing or legal advice.